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Delayed Puberty

What is delayed puberty?

Puberty that happens late is called delayed puberty. This means a child's physical signs of sexual maturity don’t appear by age 12 in girls or age 14 in boys. This includes breast or testicle growth, pubic hair, and voice changes. These are known as secondary sexual characteristics.

What causes delayed puberty?

Delayed puberty most often has no known cause. In some cases, it may run in families. In other cases, it may be caused by any of these:

Chromosomal problems

Genetic disorder

Chronic illness

Tumors of the pituitary gland or hypothalamus

Underactive pituitary gland (hypopituitarism)

Underactive thyroid (hypothyroidism)

Abnormal development of the reproductive system

Inability of the body to use androgen hormones (complete androgen insensitivity syndrome)

Too much exercise

Severe lack of eating (anorexia)

Who is at risk for delayed puberty?

A child is at risk for delayed puberty if he or she has any of these:

Parents or siblings with delayed puberty

Chronic medical conditions

Congenital syndrome

An eating disorder

What are the symptom of delayed puberty?

The symptoms are a lack of secondary sexual characteristics.

Common signs in girls can include:

No breast growth by age 12

More than 5 years between first breast growth and first menstrual period

No menstrual period by age 15

Common signs in boys can include:

No testicular enlargement by age 14

No pubic hair by age 15

More than 5 years to complete adult genital growth

The signs of delayed puberty can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is delayed puberty diagnosed?

In addition to a complete health history and physical exam, diagnosis of delayed puberty may include:

Blood tests. These are done to check hormone levels, look for chromosomal problems, and check for chronic disorders that may delay puberty. These may include diabetes or anemia.

X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child's bone age. With precocious puberty, bone age is often older than calendar age. Precocious puberty means your child's body begins changing into that of an adult (puberty) too soon. This change would occur before age 8 in girls and before age 9 in boys.

CT scan. This test uses a series of X-rays and a computer to make detailed images of the body. A CT scan can show bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.

MRI. This test uses a large magnets and a computer to make detailed images of tissues in the body.

How is delayed puberty treated?

Your child's healthcare provider will consider his or her age, overall health, and other factors when advising treatment.

Treatment for delayed puberty depends on the cause of the problem. In many cases, when the cause is treated, puberty proceeds normally. If the delayed puberty is inherited, no treatment is usually needed. In some cases, treatment may be done with hormone therapy. This helps to cause secondary sexual characteristics to occur. In other cases, surgery may be done to correct a physical problem.

What are possible complications of delayed puberty?

Delayed puberty can cause embarrassment and stress for adolescents.

How can I help my child live with delayed puberty?

Most adolescents with delayed puberty will in time develop normally and not have ongoing problems. Some causes will need treatment with hormones. Emotional support can help adolescents in dealing with their delayed puberty.